Written by Keo Kounila and Hay Phirum

Thursday, 11 June 2009

Removing obstacles in educating the next generation of medical professionals is critical step to closing health care gap with ASEAN neighbours, students and university officials say

Meas Sreyleak, a 23-year-old nursing student, is one of an emerging generation of medical professionals hoping to play her part in bringing Cambodia’s health sector up to international standards when she graduates from her four-year degree.

However, the senior at International University, the country’s first private medical university, acknowledges the goal will not be easy. Not only is the sector itself starting from a very low base, but a shortage of education options and high fees for study are hindering efforts to churn out the high-quality graduates the country needs.

“Where I study, we learn so much about how to help our patients get better, assist doctors and more,” she said.

“But everybody understands that, in order for the health sector to flourish, like in neighbouring countries, both the quality and quantity of graduates should be considered at school.”

Cambodia has just two state universities and one private medical institution – not enough to produce the thousands of medical students needed each year. It takes eight years to become a general doctor and another two years to get a medical specialist degree. Dentistry takes seven years, pharmacy five and nursing four.

Years of neglect
During the Khmer Rouge regime in the 1970s, schools, hospitals and many other social institutions were abolished. While these institutions are returning, many are still marred by corruption and poor quality.

The University of Health Science, which was originally established in 1946, was revived in the 1990s following the civil war years.

Tort Borany, a 22-year-old fourth-year dentistry student, one of around 5,000 at the institution studying  medicine, nursing, pharmacy or dentistry, said she hoped to work in a dental clinic when she graduated.

She had few complaints about the long years of study she needed to complete, but, like Meas Sreyleak, said high university fees were a matter of concern for students looking for a career in medicine.

Heng Sopanha, vice dean of the university’s Odonto-Stomatology faculty, said a medical career was a good option for students.

“Students who study here can become general doctors, a nurse, a dentist or a pharmacist,” he said. “They can work in clinics, hospitals, and in public health sectors, like the ministry or NGOs.”

Most could expect to earn at least $300 per month as a starting salary, while outstanding students could apply for scholarships to study abroad in countries like Australia, Thailand, France and Japan.

Bith Sok Tepy, a 21-year-old medical student at International University in Phnom Penh, said she was following a family tradition.

“My parents own a clinic and they want me to run it after them, so when I finish my education I will work there,” she said.
But she also revealed an independent streak, saying her personal goal was to work for an NGO or in the public health sector.

Challenges
Heng Sopanha said there was no reason Cambodia’s health education sector could not meet international standards and provide the skills needed in the country’s hospitals and clinics, though he acknowledged there were high hurdles to overcome.

“We have many problems to fight if we want to better our health education system,” he said, including the lack of modern equipment and facilities, including decent laboratories, to train students.”

Another particularly damaging issue was that people have lost faith in modern Cambodian medical practitioners due to past wrongdoings. Stories of doctors leaving patients for dead or women in labour alone have been etched in Cambodians’ memories, Heng Sopanha said.

To overcome this perception, he said the school tried to stress the importance of ethics in every class.
“Some Cambodian doctors have left a bad image behind for other good doctors to inherit, which has scared patients away from the country,” he said.

“Many go abroad for medical checkups or treatments.”

Moving toward 2010
A better future awaits Cambodian medical students if discussions with Cambodia’s ASEAN counterparts on regional medical education lead to action. Member countries have made a commitment to ensuring an equal level of educational quality is offered in all ASEAN nations by 2010.

Heng Sophana said the aim of the project was to ensure medical students from each member country felt confident enough in their own abilities to work anywhere in the regional block.

The University of Health Science was committed to meeting the goal set by ASEAN, he added.
In 2005, an independent committee was established to ensure the rights and legitimacy of all medical practitioners – foreign and national – in Cambodia.

“We want to value the quality of our education,” says Heng Sopanha, “and we have proposed that the Ministry of Health effectively pushes the independent body into practical use, so that medical graduates become confident about finding jobs to help Cambodia”.

Just as two decades of civil war in Cambodia disrupted the royal line itself, it also broke a link between generations when it comes to respect and love for the royal family.

Though its borders have always shifted, Cambodia had been a kingdom for hundreds of years when then-prime minister Lon Nol abolished the monarchy and established the Khmer Republic in 1970.

While deposed King Norodom Sihanouk remained ever-present in Cambodian politics  during the two decades of civil war that followed, on his return as King in 1993 he found his power greatly diminshed by the new Constitution.

King Norodom Sihamoni inherited this diminished role for the monarchy on his coronation as King in October 2004.

Ya Eem Chea, a 23-year-old senior in banking and finance at the Royal University of Law and Economics, said Constitutional limits on the King’s power were regrettable.

“The King and the Royal family should be more involved in economic, social and religious matters in the country, but they cannot go against the Constitution at all,” she said.

She pointed out the important role the monarchy had always played in shaping Cambodia. Retired King Norodom Sihanouk in particular had been an indefatigable figure during his reign, she said, achieving many things for Cambodia, including independence from France in 1953.

Due in part to these constitutional limits, while older Cambodians continue to hold the Cambodian Royal family in high esteem, many young Cambodians question the royalty’s relevance, said Tha Piseth, a media studies sophomore at the Royal University of Phnom Penh. “Young people of my age do not really care or know about the King or his family because they do not know the history of Cambodia very well,” he said.

Lyda Chea, a 22-year-old English-language student at the Institute of Foreign Languages, said that as the royalty became less active, there was a danger they would be forgotten entirely.

“If they’re becoming increasingly less active, we can forget if there’s a king here,” she said. “I am not sure if there is another king in line for the future … and every Cambodian like me is concerned that without the King, the country could run into chaos.”

Educating the young
Professor Sambo Manara, a teacher of Cambodian history at the Royal University of Phnom Penh, blamed the education system for what he said is a diminishing respect for the King and Royal family among young Cambodians.

“From the past until now, Cambodian people have always given a high value to the king because many good things came from kings,” he said.

Although the King today does not hold executive power like the monarchs in the past, he said, he still has an important role as protector of the Cambodian people.

“To Cambodians, having a king is like having a big umbrella,”he said.

“We don’t want to predict that Cambodia will not have a king. The concept of having a king is very important for Cambodia because his presence aids in its development. ”